Hospital reviews: Now let's fix the problems - 30/08/2007

Mr Laws said there had been a "crisis of public confidence in both the board and its leadership over the past 12 months, and that had impacted upon public confidence in the hospital itself".

"Some of that confidence will have been restored by the hospital clinical review and that is a reassurance that both our community and the wider population required. Frankly, I'm pleased that nothing irretrievable was uncovered and that the recommendations look to take the hospital from satisfactory to good.

"However, a review of the board and management itself is not so comforting. The report suggests some of the most stinging criticisms that I have ever read in a government report. The deficiencies in leadership are properly identified and they were, in many instances, systemic," said Mr Laws.

An example (page 21 of 'Wanganui Hospital Clinical Review')

LEADERSHIP

The reviewers arrived in Wanganui to find a barrage locally of very public criticism of the hospital performance, a dysfunctional Board, and a community unimpressed with and confused about the level of service being provided and the issues surrounding Wanganui Hospital. From interviews with Board members, reviewers concluded that there had been a poor understanding of the clinical volume and outcome relationship that suggests that some services should be further devolved to the community for better access, while for safety, quality, and access reasons other services should be concentrated around clinical and support facilities out of the district. Members felt that the clinical component of the assurance framework being reported to the Board was not authoritative. The Board's role in helping install clinical service collaboration across the region was unclear. Reviewers were disturbed by the lack of urgency attached to this concept at all levels in the DHB.

While on paper the hospital management structure looks top heavy, reviewers were well aware that reality can be completely different in a small compact organisation. A serious lack of clinical leadership existed in critical areas (no Heads of Department in General Surgery or O&G).

The reporting lines for Heads of Department and Clinical Directors were blurred. There is some confusion and overlap between the HOD and Clinical Director roles.

The question is raised as to the need for both in a DHB the size of Whanganui. As well as the separate DHB-wide management structure, the hospital management has clear responsibilities for DHB staff working in primary care and for developing primary secondary integration in general. These DHB-wide responsibilities also affect hospital clinicians. Only the hospital general manager is a member of the DHB–wide executive management team. Meaningful clinician manager partnership and integrated governance is severely inhibited in the absence of clinicians from the DHB–wide executive management team.

The DHB has some fine leaders in management and as Clinical HODs. Absence of the latter in general surgery and O&G is partly due to attempts to persist with unsustainable service models. Those models are discussed below. The ability to attract young general surgeons is contingent on new recruits being able to pursue the subspecialty areas of the discipline. Clinging to the generalist model is unsustainable in general surgery. Rejecting regionality concepts is unsustainable in both O&G, general surgery (and other specialities).

Mayor Laws said that there "is a very simple path ahead. That the recommendations of both reviews be implemented and that the DHB begin forging new and co-operative health, civic and community relationships".

"My council has offered our assistance in any way possible. The problems have been identified and the solutions identified. Now let's go fix those problems, move on, and create the best quality health services in provincial New Zealand."